From Henry Maudsley 20 May 1869
32 Queen Anne St | Cavendish Square W
20 May 1869.
As my present opportunities did not admit of my giving you satisfactory information in respect of the queries in your letter of 7th. Feby., I sent the letter on to my friend Dr. C. Browne, Medical Superintendent of the West Riding Asylum, who has upwards of 1000 insane patients under his constant observation, and whose acquirements are of a high order.1
He has been kind enough to send me some of the results of his experience this morning, and I now forward them, together with his note—
I trust that you may find the results useful, and I am sure Dr. Browne will be very glad to give you any further assistance which it may be in his power to give.
I am, my dear Sir | Yours faithfully | H Maudsley
West Riding Asylum, | Wakefield.
19th. May. 1869.
My dear Dr. Maudsley,
Along with this I send you some notes on "Expression" for Mr. Darwin. They are exceedingly crude & deal only with the two questions specially referred to in his letter to you.2 I have not had time to say anything upon the numerous topics suggested by the printed slip.3 To tell you the truth I have been greatly puzzled to know how to reply even to the two queries. I do not exactly understand what sort of information Mr. Darwin wishes----whether statistics cases, or generalizations founded upon experience. I have thought it safer to stick to facts.
Should the sort of information which I have sent prove of any service to Mr. Darwin I can supply him with much more of the same description
In great haste | Yours very faithfully | J. Crichton Browne
Dr. Maudsley | &c &c
Notes on the Expression of the Emotions amongst the insane and idiotic.
I have repeatedly seen the hair of the insane bristle—or as it is called stand on end—under the emotion of sudden & extreme terror.4 In a woman named Jane Leech (Ward 23) who is now under my care, the hair of the front of the head used to become partially erect whenever morphia was administered by hypodermic injection, the skin of the face becoming at the same time deadly pale & the limbs being forced in a sort of tetanic spasm. This patient’s dread of the operation is not due to the very trifling degree of pain which it occasions but is founded on the delusion that it is a method of introducing into her system a deadly poison by which her bones are to be softened & her flesh turned into dust.5 The bristling of the hair however—so common amongst the insane & observed in this case, is not always associated with the emotion of horror, or any allied Sentiment. It is perhaps most frequently seen in chronic maniacs who rave incoherently, & have destructive impulses.6 It is present in a remarkable degree in a patient of mine named Ruth Lockwood (Ward 30) whose, photograph I forward & who is affected in this way.7 She is always excited & violent, & noisy, but passes through various stages of exacerbation & mitigation, the state of her hair being a sure & convenient criterion, of her mental condition. When she is at her worst “each particular hair” does literally “stand on end”, “Like quills upon the fretful porpentine”,8 & when she is at her best her hair is more amenable to the brush & comb although it never reaches anything like an ordinary amount of subordination. The photograph was taken when it was in its most tractable humour.
In another patient of mine John Grace (Ward No 1) the hair becomes erect immediately prior to the recurence of manical paroxysms to which he is liable. It rises up from his forehead like the mane of a shetland pony.9 The same condition of the hair has been recorded in acute mania, hysterical mania, acute melancholia, & hypochondriasis.
The following case from my note book illustrates the physiognomy of Terror in an insane woman. —Grace Mellor— a patient in Ward 21. at 35. is subject to attacks of intense fear & phrenalgia—in which she fancies herself in hell.10 While in such a paroxysm she screams out “This is hell! This is hell! Oh dear! Oh dear! There are chariots of fire! There is a black woman! I can’t get out! Oh-dear! Oh dear! There are rats & horses! dont tickle me to death with feathers This is hell.” &c. When so screaming her movements are those of alternate tension & tremor. For one instant she clenches her hands, holds her arms out before her in a stiff semiflexed position, then suddenly bends her body forwards sways rapidly to & fro, draws her fingers through her hair, clutches at her neck & tries to tear off her clothes, these movements being tolerably symmetrical. Her hair at the back of her head which has been cut short, but which is brushed down when she is calm, & stands on end—that in front being dishevelled by the movements of her hands. Her countenance is very expressive of mental agony. The skin is flushed over the face & neck, down to the clavicles, & the veins of the forehead & neck stand out promently like thick cord. The sterno-cleid-mastoid-muscles11 also stand out prominently as if swollen & the skin in front of them is much wrinkled. The lower lip droops & is somewhat everted. The mouth is kept half open the lower jaw projecting. Two deep parallel lines pass, in a double curve from the outer edge of each ala nasi12 to a point—about a quarter of an inch to the outer side of each angle of the mouth. The nostrils are raised & distended. The cheeks are hollow. The eyes are widely opened & beneath each there is a raised semilunar patch (which I very frequently observe in all varieties of Melancholia) as if the loose skin of the cheek beneath the lower eyelid were puffed up or slightly œdematous. The pupils are large. There are several strongly marked furrows (divergent on to the brow) at the inner termination of each eye-brow. These are evidently produced by the powerful & persistent action of the corrugatores supercili.13 The forehead is wrinkled transversly in wavy folds.
Opposite is the photograph14 of a man who died of “horror’ & in whom the bristling of the hair was only present to a very trifling extent. He believed that he had not only brought ruin upon himself—but upon all with whom he was brought into contact—& that “an awful doom (awful because of its very vagueness’) awaited him. He was perpetually endeavouring to “fly into the arms of death to avoid the terrors of his countenance” & attempted suicide by hanging—by scratching the veins of his arm, by drowning, by beating his head upon the wall & by throwing himself before a loaded waggon. When he died no organic disease was found in his body, only emaciation, & redness of the grey matter of the brain.
I have often had occasion to observe that under the influence of rage & resentment—insane & idiotic persons, uncover & obtrusively display the teeth or “girn” as the Scotch have it. I could quote many examples of this.
1. I was recently consulted about a Lady A. Y. subject to incontrolable outbursts of anger—brought on by—jealousy & delusive suspicions, & actually saw her in one of these orgasms. At first she vituperated & foamed at the mouth. Next she approached close to her husband with compressed lips & a virulent set frown.15 Then she drew back her lips & showed her teeth, until the corners of the upper lips became almost right angles at the same time aiming at her husband a vicious blow.
2. John Smith No. 1 Ward is impulsive & readily irritated. Although an old soldier he cannot be made to conform to discipline but whenever requested to conform to the regulations of the establishment, gives way to discontent terminating in fury.16 I have repeatedly witnessed these attacks. When they take place in my presence, they are directed against me. He commences by asking if I am not ashamed of the institution, if I feel no remorse for my treatment of him? He then proceeds to swear & blaspheme, to pace up & down, to toss his arms about & to menace me & the other officers in his neighbourhood. At last as his exasperation culminates, he rushes up towards me, by a peculiar sidelong movement, shaking his doubled fist in my face, & threatening to destroy me. At that time his upper lip is drawn up on each side by the levator anguli oris,17 so that his large canine teeth are exhibited, his expression being that of great ferocity, & his curses being hissed out through his set teeth.
3. Almost the same description as that given above in the case of John Smith might apply to another patient of mine named William Wheatley (Ward 14.) who however, spits & foams in a singular manner when he is put out of temper (as he often is) & who moreover dances when he is in this condition jumping rapidly & perpendicularly upwards upon both feet, & hopping from one foot to the other as he shrieks out his maledictions in a shrill falsetto.18 This man has two of his fingers webbed together to their very points.
4. Jonathan [Kilburn] (Ward 4) an epileptic idiot (photograph enclosed) has just mind enough to feed himself which he does voraciously.19 He is incapable of independent movement & spends his whole day seated on a low stool or chair, holding an old cigar box containing a piece of tin. To these toys he is much attached becoming exceedingly irate, if any one attempts to take them from him. His temper is generally sullen & morose—but is easily lighted into fierceness, by any interference. If touched or disturbed, he slowly raises his head, from its habitual downcast position & fixes his eyes on the offender with a tardy, but angry scowl. If the annoyance is repeated he draws back his thick lips & reveals a prominent row of hideous fangs. (Large canine being especially noticeable) & then makes a quick cruel clutch with the open hand at the offending body. The rapidity of this clutch is marvellous in a being ordinarly so torpid who takes about fifteen seconds to turn his head from left to right when attracted by any noise. If when he is thus incensed a handkerchief, book or any other article be put into his hand he will drag it to his mouth & bite it.
Phthisis terminated the life of a young woman, who had fostered the growth of an inherited germ of disease by intense religious excitement, and hemiplegia and coma were the concluding stages of the case of a woman, who, though represented as having been only nine months insane at the date of her death, had probably been deprived of reason for above ten years. 20 Before her insanity was officially recognised, she had been in the habit of escaping from home, and living in solitude in the woods, feeding upon wild fruits, or what she could occasionally beg at a cottage, and sleeping amidst the brushwood. She had frequently lived in this manner for a fortnight at a time, seeking no converse with human beings. While upon one of these expeditions she was delivered of twins. At this time she was without attendance or help. She sought out a sheltered hollow for her delivery, and there, reverting to a primitive instinct, she actually gnawed through the umbilical cords with her teeth. The twins were alive when found two days after birth, but the mother was in a very exhausted state, having had no food or covering since her delivery. When brought to this asylum, she was the most perfect specimen of brutalized humanity that I have ever encountered. The most casual observers on seeing her, had powerfully suggested to them her striking resemblance to a wild animal. Her hair had all been cut or broken off short, while, over the summit of each parietal bone, the skin was quite denuded, owing to frequent rubbing, not with fingers but with the inner side of her hand and wrist. The forehead was small, receding, and deeply wrinkled. The cheek bones were naturally prominent, and appeared even more so, in consequence of the emaciation of the face, which also strongly delineated massive temporal muscles. The eyelids were without lashes, and so opened as to expose a large rounded portion of the eyeballs, thus giving the countenance a staring appearance. The width between the eyes was considerable. The bridge of the nose was depressed, the alœ wide-spread, the nostrils forward opening. The lips were thin, and always retracted so as to display a grinning set of teeth. The lower jaw was protuberant, and the chin was always held forward. The complexion was sallow, and the features exhibited no play of expression. The limbs were wasted and the fingers were fixedly contracted or flexed, and had the aspect of claws. The habits of this woman, as well as her bodily configuration, had many points in common with those of wild creatures. She was averse to a sitting posture, and preferred to lie upon the ground, or to run about in a half-stooping attitude. As she lay she drew up her legs, and twisted herself into the most singular contortions. When stared at she winked forcibly and repeatedly. She used her teeth for tearing and gnawing, as well as mastication, and she bit and licked the hands of those who fed her, as a mark of her fondness for them. She never expressed coherent thoughts, but used a few words strung together without apparently attaching any meaning to them. She constantly emitted undescribable gibbering noises. Her only attachment was for the nurses who fed her, from whom she would snatch the food brought with sudden avidity, turning away to devour it in secret. Her greatest pleasure seemed to consist in chewing a hard sea-biscuit. When awake she was invariably restless, picking, rubbing, rocking her body, and moving about. Sometimes for a whole night she would pace round her room sideways, placing her feet heavily down with the most rythmical regularity, and clasping a pillow in her arms. She was destructive to furniture, especially to crockery, which she delighted in breaking; but she did not injure her own clothing. When out in the airing court, she would pull up the flowers and grass and toss them wildly above her head. And yet this woman, presenting so many animal traits, had been of average intelligence previous to her insanity, and had adequately discharged the duties of her station in life.
J. C. B.
He forwarded CD’s queries on the insane to James Crichton-Browne who has now answered.